16 July 1966

ASPECTS OF POSTGRADUATE MEDICINE

VI-Postgraduate Medical Centres-North Staffordshire[FROM A SPECIAL CORRESPONDENT]

The North Staffordshire Medical Institute at Stoke-on-Trentmust be housed in one of the finest buildings of its kind inBritain. Nevertheless, the principles which led to its formationwere much the same as those underlying the beginning of manyother medical centres. Perhaps at Stoke the geographical factorwas rather more important than at many centres, for it isrelatively far from any medical school, and its two main hos-pitals (with 1,400 acute beds) serve a large population, and haveprogressed rapidly since the Health Service began, with theformation of several specialist units and an excellent medicallibrary. Because there was a lack of any place where large-scalemeetings could be held, and because they believed that anyfurther advances would be impossible without a programme ofpostgraduate medical education and research, some consultantsand general practitioners began discussions in 1959 on build-ing a medical centre. They also hoped that an organized post-graduate education scheme would play a valuable part inattracting junior doctors to an area where they wereexceptionally scarce, and that the community's interest in itsown hospitals would be fostered by appealing to it for funds.Many organizations were brought into the preliminary discus-

sions, which took two years, before the first appeal was sent outto local doctors in March 1961. Six months later a public appealwas launched for 100,000. This emphasized that the NationalHealth Service could not provide the money for a medicalinstitute, and that the money could be obtained only by acollective effort. It pointed out that the Institute was intendednot as a social club but to do four main things: to fosterclinical and medical research; to provide doctors working therewith technical and secretarial help; to provide an adequatereference library; and to house a programme of postgraduateeducation.

The North Staffordshire Medical Institute.

Response to the AppealThe response to the appeal (see Table) was dramatic and

came from all sections of the community-from the tradeunions, industry, and official-bodies, as well as individuals, bothlay and professional-and in the first fifteen months about£1,000 a week was received. Much of this came in small sumsfrom individual people or was raised by local enthusiasts byholding coffee mornings and garden parties. A general practi-tioner told me how one of his patients, a retired factoryforeman, who gave £5 and was invited to the opening ceremony,walked around the Institute with obvious pride showing hisfriends various features. The organizers of the Stoke Institute

Sources of Contributions

Industry, Trade, Commerce, etc.City of Stoke-on-Trent, Staffordshire County

Council, and the Borough of Newcastle-under-Lyme ... ... ... ...

Doctors and dentists ... ... ... ...Legacies ... ... ... ... ...Private donations ... ... ...Special efforts-for example, dances, garden

parties, etc. ... ... ... ...Pharmaceutical manufacturers

Pharmacists and opticians ... ...

Foundations and Trusts ... ...

Local Organizations and Societies

Trade Unions (excluding " Penny-a-week "Scheme) ... ... ... ... ...

Churches and Schools ... ... ...Anonymous ... ... ... ...

£ s. d.33,344 14 7

21,500 0 011,591 15 1010,717 9 108,813 1 11

5,723 9 65,105 15 62,614 15 82,600 0 01,606 10 0

1,383 0 3417 0 4345 16 0

105,763 9 5

hope to maintain this principle of local involvement by holdingopen days and other functions for their contributors. On theother side, some contributors have asked that their money

should be devoted to specific pro-jects-for example, the local tradeuions, whose members subscribe

to a " penny a week " fund (whichraises about £1,500 a year), havesaid that they would like this money

spent on medical research rather

than maintaining the building itself.

A suitable site for the Institute

was obtained in the grounds of the

hospital centre at Stoke, and is held

W on lease from the Hospital Manage-

t loament Committee. An interest-freeloan of £50,000 from the Nu~ffieldProvincial Hospitals Trust enabled

building to start before all themoney needed had come in, and

in October 1963 the foundation

stone was laid by Sir GeorgePickering at the British MedicalAssociation's Annual Clinical Meet-ing. The first meeting was held in

the completed building a year later,

and the Institute was formallyopened by Sir George Godber inApril 1965.The Institute is a handsome two-

storey building (see Fig,) faced in

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North Staffordshire Medical Institute

concrete, its appearance reminding one ofthe new Royal College of Physicians' build-ing in Regent's Park. Besides administrativeoffices the ground floor houses a librarian'sroom and, the library. The latter (see Fig.)contains 2,000 books, 2,300 bound periodicals,and 130 current journals; a microfilm readeris available, and it is hoped to provide photo-copying services soon, since nothing may betaken away from the library. But the dis-advantages of this are minimal, because thelibrary is open for fourteen hours six daysa week, and on Sunday mornings, and it iswithin "bleep" range of both hospitals- animportant feature for doctors on duty whoeither want to read in the library or to attendmeetings in the lecture-room upstairs,

Besides the lecture-room for 300 people'the upper floor of the Institute contains fivecarrels (or cubicles) for private study; amuseum (where there are no conventionalpathological specimens, but where a libraryof pathological material, radiographs, E.C.G.and E.E.G. tracings recorded on photo-graphic transparencies are available forindividual study, and where wall displays areexhibited); a circulation area, which canalso serve the buffet meals and parties; a kitchen and a bar.In addition, next door to the lecture hall there are changing-and waiting-rooms for patients who are presented at theclinical meetings. Two additional rooms are available forsmall meetings.

Membership and Meetings

Besides hospital doctors, general practitioners, public healthmedical officers, and postgraduate students, membership of theInstitute is open to members of many professions. Thusdentists, opticians, pharmacists, all nurses, and medicalauxiliaries (including public health department staff) are alleligible to belong, both to attend meetings and to use thelibrary. At present there are about 750 members, of whomroughly 300 pay the 3 gns. annual subscription fee fixed forfull members; the remainder pay 2 gns. annually as associatemembers-except for hospital junior staff and nurses, who donot pay at all.As in other centres, since it opened the Institute has housed

the regular meetings of established local societies, both medicaland paramedical; occasional meetings of visiting associa-

G R O U N D F L OO R P L A N F I R S T F L OO R

Plan of the Institute.

MEDICAL JOURNAL

The Library.

tions, such as the West Midlands Association of Physiciansand the regional branch of the Association of ClinicalPathologists; the long-established programme of postgraduatemedical education, including tuition of junior doctors for higherdegrees, journal clubs, and clinicopathological conferences; andlectures to the nurses. The existence of the Institute has alsomade it much easier to organize two types of formal pro-grammes for doctors taking higher degrees. One of these, inadvanced medicine, had already been held on two occasionsbefore the Institute was opened. The other, in basic sciences,is a new venture and has been held once. Both are to berepeated in the coming year. Another main group of coursesis aimed principally at general practitioners, and consistsof regular weekly lunch-time discussions; these last aboutan hour and have usually concentrated on progress in thera-peutics and management. Several one-day symposia onparticular subjects have been held-for example, on " Manage-ment of Acute Injuries" and " Pain in the Arm." Longer,full-time refresher courses are not planned at present, sincemany doctors seem to like the opportunity of going elsewherefor these, and seeing another town, and moreover there arealready an adequate number of courses within reach. So far

the organizers of the courses have foundthat an encouraging number of doctorshave come-particularly to the lunchtime

R6 1~GJ& meetings, which have been attended by upto one-third of the local family doctors.An unexpected feature has been that doctors

PATIENTS in one specialty have attended meetings inANTE- another, surgeons having come to meetings| OOM run for physicians, and hospital doctors to

ON|Din ones arranged for general practitioners.

6L |Organization and Future

MITTEE ROOM The Institute is under the direction of......... a council which has representatives of all

#MUSEUM | the professions who are eligible to joinand lay members representing the com-munity. In addition, there were severalcommittees dealing, for example, with

P L A N finance, the library, research, and post-graduate education. The total running

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16 July 1966 North Staffordshire Medical Institute ,BRU 169

costs for a year are about £7,000, of which £1,600 goes topay the salaries of the caretaker, secretaries, and part-timelibrarian and domestic staff, and the hospital managementcommittee pays four-fifths of the £7,000.As at Exeter (9 July, p. 103), many of the Institute's future

plans depend on whether a new medical school is started atStoke in association with the University of Keele, as hasbeen proposed, for clearly the well-established schemes of post-graduate education-and the Institute building itself-couldhave an important role in any future arrangements. For the

immediate future, however, the organizers of the programmedo not think that there should be any radical changes, thoughthey would like to develop the research projects and to startmeetings of sections of the professions. Thus a section ofpsychiatry has already been formed, and discussions are takingplace at present about similar ones for general practice andoccupational medicine. But it is evident that the Institutehas already gone far towards the aim stated in the appealbrochure five years ago of "becoming a medical centre ofnational importance within the next 10 years."

CONFERENCES AND MEETINGS

Golden Jubilee of Royal College of Nursing[FROM A SPECIAL CORRESPONDENT]

Nurses have never suffered from a lack ofadvice; innumerable commissions and com-mittees have in the 50 years since the founda-tion of the Royal College of Nursingdiscussed their work, education, inter-rela-tions, and staff structure, and suggested plansfor the future. On 29 June-i July the RoyalCollege of Nursing and National Council ofNurses of the United Kingdom held a con-ference in London on the occasion of itsGolden Jubilee to discuss the " Future ofNursing in a Changing Society."

Discussing " Living in a TechnologicalAge" Sir JOHN COCKROFT (Churchill Col-lege, Cambridge) described the background oflife in the next 50 years. He suggested thatchanges in the supply of energy would meanless atmospheric pollution, together with adecrease in the diseases caused by it. Thecosts of power would fall-though a speakerfrom the floor who asked why if costs fallprices do not, got no answer. Communica-tions, Sir John stated, would be faster andeasier, the demand for skilled workers wouldrise, while the need for unskilled labourwould fall.

Speaking on the same subject, Dr. A. J.WILCOCKS (Department of Social Science,Nottingham University) pointed out that atpresent families were smaller, and appearedlikely to remain so. Hence the care of theelderly infirm would have to be borne increas-ingly by the community. Men would continueto outnumber women, and those professions-such as nursing and parts of teaching-which have relied on women for their labourforce would find increasing difficulty unlessthey changed their traditional pattern. Per-haps in the future, Dr. Wilcocks thought,the age of entry to such professions wouldnormally be not 18 but 40, once child rear-ing was completed.

Nursing in a Technological AgeThe three nurse contributors to the sym-

posium all came from London teaching hos-pitals. Miss P. M. FRIEND (Matron of theLondon Hospital) said that the patient todaywas accustomed to living in a Welfare State.He expected a service that was geared to hisneeds, and not to those of a former generation

-a service run with the same efficiency andmaking as full use of technical advances ashis own industry or business enterprise, andwith standards at least equivalent to those hewas used to in his daily life.

Miss Friend went on to say that today thepatient had high expectations of the nurs-ing profession, but despite these he felt that itwas unsuitable for nurses to negotiate forhigher salaries. Thus his image of the nursereally belonged to the past. He probablywould not want his daughter to be a nurse,since he believed that she would be underpaidand overworked, and would not put to fulluse the good education he had given her.Miss Friend said that it was vital that theseconfused and conflicting impressions werecorrected, to give the true picture of nursingas a profession for the intelligent, well-educated young man or woman wishing toserve the community, and capable of usingevery modern scientific device.

Miss E. R. D. BENDALL (Principal Tutor,Hospital for Sick Children, Great OrmondStreet) had circulated a questionary to a widevariety of schoolchildren on their views onnursing as a possible career. The answerson how to choose a training school had givenmuch food for thought. Nearly all therespondents thought it a good idea to getprospectuses from several places, and themajority thought that getting an interviewwas an extremely good way of finding outwhat the hospital was like. Many felt thatan informal meeting with a present memberof the staff would be valuable, and more thanone wished to know the student nurse wastagein different hospitals. Social conditions andamenities loomed large, and local hospitalswere slightly more popular than those awayfrom home. Continuing, Miss Bendall saidthat there had been some heartfelt corre-spondence in the professional press recentlyabout the the " academic " girl and her quali-ties as a nurse. There seemed to be somedoubt as to whether human sympathy, practi-cal skill, and academic ability could go to-gether, and some fear that the profession wasgoing to be swamped by blue-stockings. Thiswas nothing more than an inverted form ofsnobbery, and did nursing a great deal ofharm. The profession needed every sixth-form boy or girl with a real desire to nurse

just as much as it needed others. In thebooklet Careers in the Hospital Service therewere listed 25 types of professional and tech-nical staff connected with diagnosis andtreatment, 19 of which asked an educationallevel far more challenging to the six-formerthan the two 0-levels asked for in nursing,while still giving the satisfaction of helpingthe sick.

Preventive MedicineProfessor W. J. H. BUTTERFIELD (Guy's

Hospital) suggested that the strain on hospi-tals could be lessened by preventive medicine,and that nurses had a great part to play inthe detection of undiagnosed disease and sub-health in the community.. Miss M. B.POWELL (Matron of St. George's Hospital)summed up the results of the conference onthe last day, and emphasized her belief thatresearch into nursing at all levels, from wardwork to teaching and administrative methods,was vital.

Speakers from the floor seemed to feel onthe whole that the technological age had notyet solved their basic problems. A youngdistrict nurse said she would be delighted topartake of the life of culture and leisurepromised when her hours of work permittedher to do so. A male nurse pleaded for parityof esteem with his female colleagues, and" a rather more neuter title than that ofsister."The message that emerged from the con-

ference was one of hope. Technology was notincompatible with compassion. Senior nursesmight be apprehensive, but young nursesaccepted the burdens imposed on them bysophisticated machines and diagnostic tools,and still retained their desire and ability togive help and comfort at basic levels.Patients' needs for food, cleanliness, andrelief of pain would not be automated. Thenurse in the technological age would need thegeneral education and professional teachingthat would enable her to function withoutanxiety in stressful situations, and the leisureto lead a normal personal life like all othermembers of the community. Given these,nursing may hope to recruit the 1 in 13 ofthe 18-year-olds that it needs.

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